scholarly journals 260. A Rare Case of Severe Group B Streptococcal Infection with Toxic Shock-like Syndrome and Diffuse Metastatic Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S129-S130
Author(s):  
Ali M Ayyash ◽  
Ly Tran ◽  
Charlie Ervin ◽  
Rahul Sampath ◽  
Teresa Campanile
Keyword(s):  
Septic Arthritis ◽  
Group B Streptococcus ◽  
Whole Body ◽  
Toxic Shock ◽  
The Past ◽  
Metastatic Infection ◽  
Wide Range ◽  
Severe Group ◽  
Group B ◽  
The Right

Abstract Background The incidence of invasive Group B streptococcal (GBS) infection has been increasing in the past decade and is currently at 10.9 cases per 100,000 population. GBS toxic shock-like syndrome is rare, with few cases reported over the past decade. The presumed etiology is the production of an uncharacterized pyrogenic toxin by certain strains. Methods We present a unique case of invasive GBS infection complicated by severe GBS-mediated toxic shock-like syndrome (TSLS) and diffuse metastatic infection. Results A 62-year-old obese male with diabetes mellitus presented with pain, swelling, and redness of the right shoulder and ankle for one week after a fall. Vitals were remarkable for tachycardia to 106 BPM and fever of 101°F with labs showing a leukocytosis to 23,500 u/L. The patient was started on ceftriaxone IV but continued to develop worsening fever, leukocytosis, encephalopathy, diffuse extremity pain, and whole-body macular erythema at 48 hours. Blood cultures grew GBS and TSLS was suspected. Adjunct clindamycin was started. MRI of the extremities demonstrated abscesses of the right levator scapulae, posterior scalene, brachioradialis, and right ankle. MRI of the spine showed epidural abscesses at L3-L5 and septic arthritis of the spinal facets at L4-L5. Operative abscess removal with joint washouts were performed by neurosurgery and orthopedics, and the patient symptomatically improved within 2 weeks on IV ceftriaxone. He was subsequently continued on cefazolin for 10 weeks and did well at follow-up. Right elbow showing a characteristic flat, macular erythema of toxic shock-like syndrome. Left arm with macular erythema. MRI showing spinal epidural abscesses at L3-L5 spinal levels (arrows). Conclusion Invasive metastatic Group B Streptococcus infection in non-pregnant adults presenting with TSLS is rare. To our knowledge, there has never been a case of GBS infection causing TSLS with rapidly developing florid metastatic infection including epidural abscess development, septic arthritis, and musculoskeletal abscesses. This case highlights the wide range of infectious possibilities associated with severe GBS infection. Disclosures All Authors: No reported disclosures

An Emerging Infection: Streptococcal Toxic Shock-Like Syndrome Caused By Group B Streptococcus (GBS), Streptococcus Agalactiae

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S140-S140
Author(s):  
F Rajack ◽  
A Afsari ◽  
A M Ramadan ◽  
T J Naab
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Streptococcus Agalactiae ◽  
Group A Streptococcus ◽  
Multiorgan Failure ◽  
Group B Streptococcus ◽  
Stage Iii ◽  
Streptococcal Toxic Shock Syndrome ◽  
Toxic Shock ◽  
Group B

Abstract Introduction/Objective Streptococcus agalactiae, Group B Streptococcus (GBS), is a major cause of neonatal sepsis and infections in pregnant women. However, incidence of invasive GBS infections has more than doubled in the last two decades with highest risk in adults 65 years or older. Other risk factors are diabetes, malignancy, and immunocompromised state. Bacteremia and skin soft tissue infections are the most common invasive infections in nonpregnant adults. Rarely GBS infection has a fulminating pyrogenic exotoxin-mediated course characterized by acute onset, multiorgan failure, shock, and sometimes death, referred to as toxic shock-like syndrome. Methods A 77-year-old hypertensive female with uncontrolled type 2 diabetes mellitus and a history of bilateral foot ulcers presented to the hospital in probable septic shock. Clinical diagnosis of necrotizing fasciitis was made and she underwent bilateral lower limb amputations. Results Grossly soft tissue appeared gray. Microscopically fascia was necrotic without neutrophils present and Gram stain revealed sheets of Gram positive cocci. These findings reflected histopathologic Stage III necrotizing fasciitis, which is associated with 47% mortality. Autopsy showed a similar histology of Stage III necrotizing fasciitis involving the surgical stump. Erythema and desquamation of the upper limbs bilaterally and multi-organ failure met the clinical picture of Streptococcal Toxic Shock Syndrome (STSS) and fulfilled the criteria for TSS due to Group A Streptococcus (GAS), defined by The Working Group on Severe Streptococcal Infections. Conclusion Group B Streptococcal Toxic Shock-Like Syndrome may have a similar outcome to STSS caused by GAS and other pathogens and, in limited studies, mortality has been 30% or greater.

scholarly journals A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya

2011 ◽  
Vol 5 (11) ◽  
pp. 799-803 ◽  
Author(s):  
Ruchika Kohli-Kochhar ◽  
Geoffrey Omuse ◽  
Gunturu Revathi
Keyword(s):  
Developing Countries ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Gram Positive ◽  
Late Onset Sepsis ◽  
Group B ◽  
The Right

Introduction: Neonatal mortality in developing countries is usually due to an infectious cause.  The gold standard of investigation in developing countries is a positive blood culture.  It is important to know the aetiology of neonatal bloodstream infections so that empiric treatment can be effective.  Methodology: We conducted a retrospective clinical audit over ten years between January 2000 until December 2009, looking at the aetiology of both early and late onset neonatal sepsis.  We analysed data from 152 (23%) patient isolates out of 662 suspected cases of neonatal sepsis.  Results: Our study revealed that Gram-positive organisms were the predominant cause of both early and late onset sepsis; the common isolates were Staphylococcus epidermidis (34%) and Staphylococcus aureus (27%).  There were no isolates of group B Streptococcus.  Candida species was isolated only in patients with late onset sepsis (6.9%).  Bacterial isolates were relatively sensitive to the commonly used first- and second-line empiric antibiotics. Conclusion: Gram-positive organisms remain the major cause of neonatal bloodstream infections in our setup.  The findings of this study will guide clinicians in prescribing the right empiric therapy in cases of suspected neonatal sepsis before the definitive culture results are obtained.

Group B Streptococcal Infections in Neonates

1979 ◽  
Vol 1 (1) ◽  
pp. 5-15
Author(s):  
Carol J. Baker
Keyword(s):  
Group B Streptococcus ◽  
Newborn Infants ◽  
Neonatal Infection ◽  
Etiologic Agent ◽  
Diagnostic Methods ◽  
Bacterial Disease ◽  
Absolute Increase ◽  
Mortality And Morbidity ◽  
The Past ◽  
Group B

β-Hemolytic streptococci of Lancefield group B have been causally linked to neonatal disease since 1938, but only in the last decade has the group B Streptococcus become the leading etiologic agent for bacteremia and/or meningitis occurring during the first two months of life. Neither the reasons for the emergence of this organism nor the shifts over the past 40 years in the prevalence of various bacteria responsible for neonatal infection has been adequately explained. However, the importance of the group B Streptococcus as a frequent cause of neonatal mortality and morbidity demands a thorough understanding of the epidemiology and pathogenesis, clinical features, diagnostic methods, and management of these infections by physicians caring for newborn infants. INCIDENCE The common occurrence of neonatal group B streptococcal septicemia and meningitis in several geographically distant centers since 1970 has allowed the relatively precise determination of attack rates for early onset type (≤5 days) infection. Reported attack rates have been surprisingly uniform, varying from 1.3/1,000 to 4.0/1,000 live births (Table 1). Because the attack rates for serious neonatal infections associated with Escherichia coli and other maternally acquired coliform organisms have been constant since 1960, the appearance of the group B Streptococcus resulted in an absolute increase in the incidence of neonatal bacterial disease during the past decade in many hospitals in this country.

Septic Arthritis of the Hip Caused by Group B Streptococcus in a Postpartum Patient

2012 ◽  
Vol 2 (4) ◽  
pp. e62 ◽  
Author(s):  
Anokhi D. Mehta ◽  
Kathleen S. Beebe ◽  
Daniel A. Seigerman ◽  
John D. Koerner ◽  
John S. Hwang ◽  
...  
Keyword(s):  
Septic Arthritis ◽  
Group B Streptococcus ◽  
Group B

scholarly journals Diffuse-Type Tenosynovial Giant Cell Tumor of the Knee with Concurrent Polymicrobial Infection (Klebsiella oxytoca and Group B Streptococcus)

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
J. Hunter Marshall ◽  
John G. Skedros ◽  
Chris F. Campana ◽  
Allan M. Seibert
Keyword(s):  
Septic Arthritis ◽  
Giant Cell ◽  
Klebsiella Oxytoca ◽  
Group B Streptococcus ◽  
Pigmented Villonodular Synovitis ◽  
Acute Onset ◽  
Left Knee ◽  
Diffuse Type ◽  
Giant Cell Tumors ◽  
Group B

Tenosynovial giant cell tumors (TGCT) are a rare class of benign proliferative tumors that are classified according to their presentation: localized-type (L-TGCT) or diffuse-type (D-TGCT). TGCT is synonymous with pigmented villonodular synovitis (PVNS). We describe the unique case of a 56-year-old obese male with type 2 diabetes who had polymicrobial septic arthritis of his left knee joint with concurrent D-TGCT in the same knee. While on a vacation, he noticed spontaneous left knee pain and swelling with an acute onset of fever. He was diagnosed with septic arthritis that was attributed to hematogenous spread from a leg laceration. The septic arthritis was treated with arthroscopic lavage and debridement, including simultaneous excision of the D-TGCT lesions, followed by intravenous ceftriaxone. Cultures of the synovial tissue that were obtained during arthroscopy grew Klebsiella oxytoca and beta-hemolytic (group B) Streptococcus agalactiae. We were not able to find another reported case of any joint with (1) a polymicrobial bacterial infection that included Klebsiella oxytoca and (2) concurrent bacterial septic arthritis and TGCT.

scholarly journals Response of Group B Streptococcus to the Combination of Gold Nanoparticles-Erythromycin as a Nanoweapon

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Leila Fozouni ◽  
Prastoo Vaezi ◽  
Ania Ahani Azari
Keyword(s):  
Gold Nanoparticles ◽  
Pregnant Women ◽  
Rural Areas ◽  
Group B Streptococcus ◽  
Antibacterial Properties ◽  
Diffusion Method ◽  
Broth Microdilution ◽  
Wide Range ◽  
Broth Microdilution Method ◽  
Group B

Background: Group B Streptococcus (GBS) causes a wide range of adverse effects in both mothers and infants during pregnancy and after delivery. Objectives: This study aimed to evaluate the effects of erythromycin either alone or in combination with gold nanoparticles (AuNPs) on the clinical GBS isolated from pregnant women. Methods: This descriptive cross-sectional study was performed on 106 women aged 16 - 48 years. After identification of GBS strains by phenotypic and genotypic methods (PCR), erythromycin-resistant isolates were identified using the Kirby-Bauer test and broth microdilution method according to CLSI-2015 guidelines. The antibacterial properties and minimum inhibitory concentration (MIC) of erythromycin (either alone or combined with AuNPs) were assessed by the agar well-diffusion and broth microdilution methods, respectively. Results: The frequency of GBS isolates was significantly high in the pregnant women aged less than 40 years (73.9%) (P = 0.0251), those with a history of abortion (60.9%) (P = 0.038), and residents of rural areas (60%) (P = 0.038). Moreover, 65.2% of the isolates were resistant to erythromycin. The MIC of AuNPs-erythromycin combination required to inhibit the growth of 50% of GBS isolates (MIC50 = 0.25 μg/mL) was significantly lower than the concentration of AuNP-erythromycin required to inhibit the growth of 90% of the isolates (MIC90 = 1 μg/mL) (P = 0.02), indicating a 16-fold lower dose than the values for erythromycin and AuNPs alone. In the agar well-diffusion method, the average diameter of the growth inhibition zone of AuNPs-erythromycin was 2.5-fold greater than that of free erythromycin (P = 0.037). Conclusions: The results showed that the combination of erythromycin with AuNPs increased the antibacterial effects of erythromycin against GBS isolates.

scholarly journals Novel Multiplex Immunoassays for Quantification of IgG against Group B Streptococcus Capsular Polysaccharides in Human Sera

mSphere ◽  
2019 ◽  
Vol 4 (4) ◽  
Author(s):  
Giada Buffi ◽  
Bruno Galletti ◽  
Maria Stella ◽  
Daniela Proietti ◽  
Evita Balducci ◽  
...  
Keyword(s):  
Group B Streptococcus ◽  
Magnetic Microspheres ◽  
World Health ◽  
Capsular Polysaccharides ◽  
Medical Need ◽  
Luminex Technology ◽  
Wide Range ◽  
Human Sera ◽  
Group B

ABSTRACT Group B Streptococcus (GBS) infections constitute a major cause of invasive disease during the first three months of life and an unmet medical need that could be addressed by maternal vaccination. The GBS capsular polysaccharides (CPSs) have shown promise as vaccine targets in clinical studies. A highly specific serological assay to quantify maternal and neonatal anti-CPS antibody levels will be instrumental for GBS vaccine licensure. Here, we describe the development and comparison of two novel multiplex immunoassays (MIAs) based on the Luminex technology for the quantification of IgG antibodies recognizing the five most frequent GBS capsular variants (Ia, Ib, II, III, and V) out of the ten types identified. The first assay is based on the use of biotinylated CPSs coupled to streptavidin-derivatized magnetic microspheres (Biotin-CPS MIA), while the second is a sandwich assay with plain CPSs coupled to magnetic microspheres coated with polysaccharide-specific mouse monoclonal antibodies (Sandwich MIA). Both assays showed good specificity, linearity, and precision, although the Biotin-CPS MIA presented higher sensitivity and lower complexity than the Sandwich MIA. A panel of human sera representing a wide range of anti-CPS IgG concentrations was tested in parallel by the two assays, which resulted in comparable titers. Our data support the preservation of antigenic epitopes in the biotinylated polysaccharides and the suitability of the Biotin-CPS MIA for the precise determination of GBS anti-CPS IgG concentrations in human sera. IMPORTANCE Group B streptococcal infections can cause death in neonates up to 3 months of age. Intrapartum antibiotic prophylaxis in GBS-colonized mothers has limited early infections but has no impact after the first week of life. The development of a maternal vaccine to address this unmet medical need has been identified as a priority by the World Health Organization, and the GBS CPSs are considered the best antigen targets. However, to date there are no accepted standardized assays to measure immune responses to the investigational vaccines and for establishment of serocorrelates of protection. Here, we describe the performance of two microsphere-based pentaplex immunoassays for the determination of antibodies recognizing the five most frequent GBS serotypes. Our data confirm that an assay based on biotinylated polysaccharides coupled to streptavidin microspheres would be suitable for the intended purpose.

“Disability Grief”: A patient’s allegorical expression of her disability

2020 ◽  
Author(s):  
Abdorreza Naser Moghadasi
Keyword(s):  
Disease Onset ◽  
Daily Work ◽  
The Past ◽  
Wide Range ◽  
Relapsing Remitting ◽  
The Future ◽  
The Central Nervous System ◽  
The Right ◽  
Professional Artist

Multiple sclerosis (MS) is an autoimmune disabling disease of the central nervous system, and can lead to a wide range of symptoms. Although the most common form of MS is relapsing-remitting, most of the patients also will develop disability in the future due to the natural course of the disease.1,2 The disease onset mostly occurs in 27 years of age.3 Therefore, considering the symptoms and complications of the disease, it can virtually affect the whole life of the patient. Unfortunately, there is not any accurate study of the opinions of patients with MS regarding their illness. However, in the daily work of treatment, one of the well-known cases of severe discomfort expressed by patients is the fear of future disability. This issue is aggravated when a person starts to lose abilities. When the patient experiences disability in walking and a decrease in his/her daily activities, thinking about the future becomes one of his/her major concerns. Most patients express these concerns in their visits. However, a patient who has other abilities such as poetry, writing a story, or painting, can more effectively portray concerns. The painting reported here is the allegorical view of a patient about her disability. The patient is a 37-year-old woman who has had MS for 15 years. Her illness started with the right eye optic neuritis. She has had six attacks during this period and, after 9 years, her disease entered the secondary progressive phase. Her symptom in this stage was the weakness of the right lower extremity, which was gradually deteriorating such as difficulty in walking. Now, she is unable to walk without help. This disability has affected all aspects of her life, and has greatly diminished her quality of life. She has been interested in drawing since childhood, and has drawn as a non-professional artist. One of her paintings reported here (Figure 1), according to the patient herself, reflects her perception and grief over her progressive disability. She believes that she should say goodbye to her ability and good days of the past. She painted herself as someone (when she could walk unrestrictedly) moving away along with a balloon

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